Risk factors for multidrug‐resistant Gram‐negative bacteria infection in intensive care units: A meta‐analysis

Ang, Hui Ying; Sun, Xuan

doi:10.1111/ijn.12644

Cited by 35 publications

(26 citation statements)

References 46 publications

(126 reference statements)

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“…For antibiotic treatment, the present study found that prior antibiotic treatment was a significant risk factor for MDR bacterial infection in LRTIs. This finding is similar to that of the previous studies, which identified the risk factors for MDR PA infection in hospitalized patients [ 44 ] and MDR GNB infection in intensive care units [ 45 ]. The above two systematic reviews could not specify the definitions of previous antibiotic use, nor can they conclude an exact cutoff point for the time frame.…”

Section: Discussionsupporting

confidence: 92%

Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

Chen

Sun

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Background. Multidrug-resistant (MDR) bacteria are the main cause of lower respiratory tract infections (LRTIs) with high mortality. The purpose of this study is to identify the risk factors associated with MDR by performing a systematic review and meta-analysis. Methods. PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. Results. A total of 3,607 articles were retrieved, of which 21 articles representing 20 cohort studies published in English were included after title/abstract and full-text screening. Among the 21 articles involving 7,650 patients and 1,360 MDR organisms, ten reported the risk factors for MDR Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), ten for MDR GNB, and one for MDR GPB. The meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Conclusions. This review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future.

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Section: Discussionsupporting

confidence: 92%

Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

Chen

Sun

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…This is because patients who had required MV or undergone tracheotomy can easily be exposed to MDRO colonization 12. ICU admission or broad-spectrum antibiotic use also contributes to MDRO infection,30 and changes to the airway structure are a further risk factor. Meanwhile, in our hospital, the rehabilitation department is famous in Guang Zhou, and there are many patients with tracheotomy coming to that department for rehabilitation treatment.…”

Section: Discussionmentioning

confidence: 99%

<p>Differences in microbial etiology between hospital-acquired pneumonia and ventilator-associated pneumonia: a single-center retrospective study in Guang Zhou</p>

Feng

Zhou

Zou

et al. 2019

IDR

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Purpose: Nosocomial pneumonia is a common nosocomial infection that includes hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia(VAP). It is an important cause of morbidity and mortality in hospitalized patients. This study aimed to evaluate the differences in microbial etiology and outcomes between HAP and VAP, particularly in related risk factors of multidrug-resistant organism (MDRO) causing HAP and VAP. Patients and methods: This single-center retrospective, observational study included patients with HAP/VAP. Clinical and epidemiological data of nosocomial pneumonia confirmed by microbial etiology that occurred in the Third Affiliated Hospital of Sun Yat-sen University, China, from January 2014 to December 2017 were obtained. Results: A total of 313 HAP cases and 106 VAP cases were included. The leading pathogens of HAP and VAP were similar, including Acinetobacter baumannii, Pseudomonas aeruginosa , and Klebsiella pneumoniae . Antimicrobial susceptibility of the pathogens was low, and P. aeruginosa in VAP was less susceptible. In the multivariate logistic regression analysis, the risk factors associated with MDRO-HAP were chronic obstructive pulmonary disease, antibiotic therapy in the preceding 90 days, and prior endotracheal tracheostomy. The risk factor of MDRO-VAP was ≥5 days of hospitalization. The 30-day mortality rates of HAP and VAP were 18.5% and 42.5%. Conclusion: The leading pathogens were similar in both HAP and VAP, and antimicrobial susceptibility of the pathogens was low. The risk factors associated with MDRO infection in HAP and VAP have significant variability; hence, attention should be paid to improve prognosis. VAP was associated with poorer outcomes compared with HAP.

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“…Case-control studies examining risk factors for isolating Carbapenemase-resistant Enterobacterales (CRE) found recent antimicrobial administration, and carbapenems specifically, to be the largest risk factor [63,64]. Likewise a recent meta-analysis, specifically looking at the risk factors for MDR Gram negative bacteria infection in ICUs, found previous antimicrobial therapy to be key [65].…”

Section: Mechanism: Antimicrobial Resistancementioning

confidence: 99%

Antimicrobial-associated harm in critical care: a narrative review

et al. 2020

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The belief that, for the individual patient, the benefit of prompt and continued use of antimicrobials outweighs any potential harm is a significant barrier to improved stewardship of these vital agents. Antimicrobial stewardship may be perceived as utilitarian rationing, seeking to preserve the availability of effective antimicrobials by limiting the development of resistance in a manner which could conflict with the immediate treatment of the patient in need. This view does not account for the growing evidence of antimicrobial-associated harm to individual patients. This review sets out the evidence for antimicrobial-associated harm and how this should be balanced with the need for prompt and appropriate therapy in infection. It describes the mechanisms by which antimicrobials may harm patients including: mitochondrial toxicity; immune cell toxicity; adverse drug reactions; selection of resistant organisms within a given patient; and disruption of the microbiome. Finally, the article indicates how the harms of antimicrobials may be mitigated and identifies areas for research and development in this field.

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Risk factors for multidrug‐resistant Gram‐negative bacteria infection in intensive care units: A meta‐analysis

Abstract: Six risk factors were associated with multidrug-resistant Gram-negative bacterial infection in intensive care units. Antimicrobial stewardship, infection control, and medical staff prevention care are needed.

Cited by 35 publications

References 46 publications

Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

<p>Differences in microbial etiology between hospital-acquired pneumonia and ventilator-associated pneumonia: a single-center retrospective study in Guang Zhou</p>

Antimicrobial-associated harm in critical care: a narrative review

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